This article is written by Tanisha Prashant, a student of Institute of law, Nirma University, Ahmedabad. Here the author discusses the mental health in India.
Recently, a debate that engaged economists worldwide was whether or not to measure countries well being by analyzing the percentage of happy people residing in the country. India showed disappointing results by dropping low to a rank of 133 and falling behind countries like Pakistan and Africa. While measuring this subjective well being, an important factor is the mental health of the citizens of a country. Though a highly contingent factor, the role of state yet cannot be ignored and still plays a prominent role. The state plays a huge role in keeping its citizen healthy both mentally and physically. While the physical well being is often noticeable and easily accessed and cured, the attention to mental well being is at its lowest in a country like India. This lack of care and a state of ignorance that has been adopted by the countrymen is unfortunate.
Mental health in India has never been an open topic and can be associated with a taboo at certain points. The awareness regarding mental illness is nil among the citizens, even if they discover some mental illness it can’t be expected out of them to go and seek remedies. Mental illness in today’s world is something of prime importance for a country, ignoring human capital is not acceptable for a developing country like India. Owing equal attention to individuals in the country is beneficial in socially, culturally and especially economically. It is shown that countries with a high amount of mental illness go through tremendous economic drops and losses.
According to a recent National Mental Health survey, approximately 150 million people in India need care for their mental health condition. Common mental disorders, including depression, anxiety disorders and substance use disorders affect nearly 10% of the Indian population. According to the Human Right Watch, only 0.06 per cent of India’s health budget is devoted to mental health and available data suggests that state spending in this regard is abysmal. In a survey of 3,556 respondents from eight cities across India, a staggering 47% could be categorized as being highly judgmental of people perceived as having a mental illness according to the live love laugh foundation, a non-profit organization. In the same survey, it was highlighted that 26% of the individuals were afraid of the mentally ill people. Mental health patients, according to the WHO, are receiving the worst care and support possible and live their lives in a state of utter disregard by their fellow countrymen. Only 14% of individuals receive long term care and actual benefits from treatments. For every 1000 patients, there are 0.3% of health professionals available in the country. Mental hospital expenditures are not available. Increased suicides rates among citizens, decreased life expectancy, and low economic growth all are the issues that have one answer to it, healthy mental lives of the citizens.
The Mental Health Care Act: The Journey
Mental healthcare in India has had a fair share of legislation. Pre-independence existed the Indian lunatic asylum act, 1858, which was later modified to Indian lunacy act, 1912. The Act not only gave a separate term to the mentally ill but also did very little to help them, creation of asylums though was authorized was done in a minimalistic way. The lunatic word gave them social exclusion and worsened their condition. The act was drafted with the motive of protecting the people from lunatics and thus, resulted in total isolation of the lunatics leading to a grave violation of rights and cruelty. Therefore, to do away with the previous evils of the act, the mental health act was passed in the year 1987 which acted more liberally and softly towards the mentally ill.
It repealed the Indian lunacy act 1858. The act was divided into 10 chapters with 98 sections. Terms like mentally ill rather than lunatics were used. Psychiatric hospitals instead of asylums and mental hospitals were used. A more interactive and advanced system of approach was established by dividing powers between the centre and the state. Separate hospitals for juveniles were established. The procedure of admission was also modified and was made less stringent.
Some features of the Act
Involuntary admission of the patient couldn’t exceed 90 days, the patient could come in voluntary if he is a major.
This act also recognized human rights and said that no physical or mental indignity would be given to patients.
He/she cannot be made a subject to research until and unless it benefitted him directly. Provided check on hospitals by appointing inspecting officers. Simple procedures existed for admission and discharge of mentally ill persons to hospitals.
Guardians were appointed for maintaining property and person of the mentally ill. The act gave Provision for bearing the expenses of treatment by relatives and government. Provided for a separate place for children, addicts and convicted persons.
Though the mental health act 1987, did alleviate the conditions to some level but didn’t make it the way it was supposed to be. Increased health care costs with little budget allocation, more pressure on hospitals and doctors than the government, post-discharge and rehabilitation care was not present.
Educating society was not taken as a measure, change of terminologies helped only theoretically and not practically.
The amendment of the act was critical because of two landmark developments. At the national level most exemplary amendments into the Protection of Human Rights Act of 1993 with advanced concerns of human rights and its protection, gave new dimensions and understanding to certain aspects of the society. At the International level, the most wanted ratification of the Convention on Rights of Persons with Disability in October 2007 further made it necessary to amend the laws.
In the year 2017, the mental health care act, 2017 was introduced, which repealed the earlier acts. it viewed the issue from a rights-based approach. The act was described as an act to provide mental health care and services to protect, promote and fulfil the rights of such persons during delivery of mental health care and services and for matters connected therewith or incidental thereto. The act defines “mental illness a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognize reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs, but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterized by subnormality of intelligence.”
Justice NV Ramana, Justice Mohan M. Shantanagoudar and Justice Indira Banerjee observed that Section 20 (1) of the Mental Health Care Act explicitly provides that ‘every person with mental illness shall have a right to live with dignity.’
It decriminalizes suicide and prohibits electroconvulsive therapy. It is, however, out of bounds for minors. Every person will have the right to access mental healthcare services. Such services should be of good quality, convenient, affordable, and accessible. This act further seeks to protect such persons from inhuman treatment, to gain access to free legal services and their medical records, and have the right to complain in the event of deficiencies in provisions. The act also recognizes the right to community living; right to live with dignity; protection from cruel, inhuman, or degrading treatment; treatment equal to persons with physical illness; right to relevant information concerning treatment, other rights and recourses; right to confidentiality; right to access their basic medical records; right to personal contacts and communication; right to legal aid; and recourse against deficiencies in provision of care, treatment, and services. However, the estimate of the expenditure required to meet the obligations under the law is not available. It is also not clear how the funds will be allocated between the central and the state governments. The concept of advance directive, which gives patients more power to decide certain aspects of their own treatment, has been picked up from the West. However, unlike developed countries, local factors such as existing mental health resources and lack of awareness about mental illness in India have not been taken into account. Mentally ill persons who suffer from serious psychological disorder often lack the ability to make sound decisions and do not always have a relative to speak on their behalf.
Legislations like the rights of disabilities act 2017 recognizes mental disability and provides various benefits to the mentally ill by putting tools of social inclusion in their hands.
Issues and Challenges
It overlooks the avoidance and advancement of mental prosperity rather makes it carefully a clinical issue. The Act does not give a reasonable method of setting up the Advance Directive. Further, specialists are of the sentiment that they are in the best position to make choices on parts of treatment since patients or their designated agents may have restricted information on emotional wellness and psychological maladjustment. The Act gives a thin and limited meaning of psychological well-being experts and does exclude psychotherapists, instructors and psychoanalysts. In contrast to the Act of 1987, the Bill does not accommodate the board of property of mentally ill people. This is a genuine aim of worry as mentally ill people could without much of a stretch be abused and their property detracted from them, leaving such people in a ceaseless condition of reliance. The monetary update of the Bill does not evaluate the use required for gathering the commitments under the Bill nor does it give subtleties of the sharing of costs between the focal and state governments. Without the allotment of satisfactory assets, the usage of the Bill could be influenced.
Several states face financial constraints, the central government might have to step in to ensure funds for the implementation of the law.
Erwadi Tragedy In 2001, 28 patients who were chained at a home for mentally-ill people died after a fire that engulfed the home in Erwadi village (Tamil Nadu). The incident highlighted the need for organized and human approach to mental health care. It highlighted the reformation of jail like mental hospitals. The grave human rights violations and the utter cruelty that the patients are subjected to cannot be ignored at any point.
In the wake of momentum rights arousing procedure inundating the world, the need of an increasingly sympathetic methodology towards our own one of a kind kinsmen .psychological wellness isn’t a malady or an issue to be looked down on, it’s something equivalent to having a cold or a viral fever which can be relieved. Given the correct sort of consideration. Dismissing it will just compound it. Enactments have constantly encompassed an issue, however just on the off chance that it could help reduce the continuous issues of the harmed. Teaching and sharpening the natives appears the best way to approach this issue. The absence of training at the piece of the natives in managing rationally sick is an unsettled issue. Disguise as opposed to systematization is the roadway to managing emotional well-being issues and accomplishing better monetary social and social worldwide guidelines.