March 27, 2017
Ratna De Nag speaks on The Mental Healthcare Bill, 2016
FULL TRANSCRIPT
Thank you Sir for giving me the opportunity to speak on The Mental Healthcare Bill, 2016. The Bill seeks to promote and improve the rights of the patient in need of the mental healthcare.
National Human Right Commission conducted a detailed study of the patients in mental institutions and condition they live in. They found numerous instances of cruel treatment – people being beaten, people being chained and being denied dignity of any kind.
Sir, at present we have about 300 district mental health programmes. But the effectiveness of the programmes varies across the States because of the restricted funding, lack of trained human mental health care providers and low motivation among the health providers at the all stages.
The access to mental health programmes is going to be a big concern in India. Up to 40% of the patients do not get access to the mental health programme because they have to travel more than 10 km.
Depression is the leading cause of death in the world and it is the second leading cause of death among 15-29 years old. According to World Health Organisation, about 350 million people suffer from depression worldwide. As per the National Crime Records Bureau, 1.31 lakh people committed suicide in India in 2014. Lack of funding, lack of human resources, and social stigma associated with mental illness – along with lack of access – are the main reasons for the failure of effectiveness of these programmes.
Lack of funding, lack of human resources, and social stigma associated with mental illness – along with lack of access – are the main reasons for the failure of effectiveness of these programmes. There are about four thousand psychiatrists in India. Most of them are in the private practice, so there is a massive shortage of psychiatrists in the public sector. This will lead to large number of people, requiring treatment, remaining undiagnosed.
But Sir, there are some good provisions in the Bill also. For example, Advanced Directive, stating how he or she wishes to be treated for a future mental illness also how he does not wish to be treated. Such an Advanced Directive can also be challenged by families, professionals.
Decriminalisation of suicide is a much needed reform. A person attempting suicide shall be considered to be under serious stress and will not be liable to be prosecuted under Section 309 of IPC. The Government shall provide care, treatment and rehabilitation to all such persons.
Another good provision, Sir, is that the Bill provides protection to patients from cruel, inhuman and degrading treatment. Some treatments currently being used will be prohibited, most importantly, electroconvulsive therapy given without anesthesia and the practise of chaining the patients to their bed.
But, there are some points Sir, I would like to raise. The Provision of appointing a nominee and then subsequent decisions being taken by them may lead to damage to the bonding and goodwill between the families.
Furthermore, a mental patient can only be admitted in a mental institution after review by the Mental Health Review Commission.This may lead to undue delay in the treatment and make the entire process more complicated. Furthermore, this reason may discourage the families from playing a proactive role.
The Mental Health Review Commission has six members, out of which one is a psychiatrist and another a mental healthcare personnel. This means that it will lead to crucial decisions being taken in the field of mental health by a non-expert.
The Bill speaks about ECT, that is, electroconvulsive therapy in the case of some mental illnesses for minors. But, Sir, the Board advises it with the consent of the parents with prior permission of a psychiatrist. Sir, due to serious hazards of electroconvulsive therapy on minors, it is a controversial implementation in the case of mental health issues of a minor, and so a blanket ban on electroconvulsive therapy for the treatment of mental illnesses of minors should be implemented, as advised by the World Health Organisation.
The Bill states that medical records can be assessed by the patient unless it causes a “serious mental harm”. But there is no definition as to what would constitute a “serious mental harm”, and it is linked to the psychiatrist’s decision. This may lead to unscrupulous people taking advantage of these patients for their own benefits. Sir, the Bill must provide for a stringent punishment in cases of falsifying medical records.
The Bill states that there shall be one district board for eight north-eastern States covering at about 262.230 sq km. This would make it inaccessible to large number of people, due to difficulties in connectivity and terrain.
Sir, the Bill states about the community-based rehabilitation establishment and health services. But is not defined. A clear-cut definition is required.
Sir, I would request the Hon. Minister to:
- include Dementia under Mental Healthcare Bill,
- incorporate a neurologist in the Board,
- ensure that the admission and discharge of a mental patient in a mental health institution should be under the jurisdiction of the physician,
- organise regular mental health awareness camps. They can be organised by government and non-government organisations,
- review and assess the programme by an expert, and finally,
- assess and analyse the benefit of the programme and response of the people.
I would request the Hon. Minister to look into these issues so that the country gets a good Bill and we are able to eradicate the social stigma associated with mental illness.
Thank you, Sir.
