August 8, 2016
Ahamed Hassan Imran speaks on The Mental Health Care Bill, 2013
Sir, on August 6, 2001, a fire broke out in an asylum in Erwadi, Tamil Nadu. More than 25 patients were burnt alive; they could not escape the blaze as they had been chained to poles or beds. The Supreme Court stated that the ‘Mental Health Act, 1987 is not at all implemented by the concerned authorities and there is failure on the part of Central/State Governments to implement the 1987 Act.’ Thus, there is an urgent need to introduce and implement sweeping reforms in the country.
The National Human Rights Commission (NHRC) has conducted detailed studies of patients in mental institutions and the conditions they live in. They found numerous instances of cruel treatment and people being chained, being beaten, and being denied any kind of dignity.
There are around 4,000 psychiatrists in India, and many of them are in private practice. Thus there is a massive shortage of psychiatrists in the public sector, which has led to a large number of people requiring mental healthcare remaining undiagnosed.
As per National Crime Records Bureau (NCRB) data, 1,31,666 people committed suicide in India in 2014. Depression is the leading cause of suicide around the world and needs to be treated by healthcare professionals. There is a need to eliminate the social stigma associated with mental disorders.
Access to mental health services in India continues to be a major challenge as up to 40 per cent of patients travel more than 10 km to access District Mental Health Programme services.
Coming to the Mental Health Care Bill, 2013, it has some good provisions. Any person, with or without mental illness, can make an Advance Directive (AD) stating how he/she wishes to be treated for a future mental illness and also how he does not wish to be treated. Such an AD can also be challenged by families, professionals, etc. Decriminalisation of suicide is a much-needed reform. A person attempting suicide shall be considered to be under severe stress and will not be liable to be prosecuted under Section 309 of Indian Penal Code. The Government shall provide care, treatment and rehabilitation to all such persons.
The Bill states that it is the obligation of the Central and State Governments to build halfway homes and community care centres, among others, for the mentally ill. Such services should be affordable, of good quality and available without discrimination. It also provides protection to patients from cruel, inhuman and degrading treatment. Some treatments currently being used will be prohibited, most importantly, electro-convulsive therapy (ECT) given without anaesthesia and the practice of chaining patients to their beds.
However, there are some issues with the Bill which I would like to raise. The provision of appointing a nominee, and then all subsequent decisions being taken by the nominee may lead to the damaging of goodwill and bonding between the members of a family. Furthermore, a person can only be admitted to a mental healthcare facility after being reviewed by a Mental Health Review Commission (MHRC) panel. This might cause undue delay to the treatment, and will make the entire process more complicated. These reasons might discourage families from playing a proactive role in seeking treatment.
The MHRC has six members, but out of which only one is a psychiatrist and another a mental healthcare professional. This will lead to crucial decisions being taken in the field of mental health by of non-experts.
The Bill allows for ECT on minors in case the psychiatrist advises it, with the consent of the guardian and prior permission of the Board. However, due to its extreme side effects and its controversial practice in the treatment of mental illness in minors, a blanket ban on ECT for minors should be implemented, as recommended by the World Health Organisation.
It is surprising that the Bill provides for only one District Board for the eight north-eastern states of India, covering an area of 2,62,230 sq km. This would make it inaccessible to a majority of the people in these States, who face difficulties because of connectivity issues and terrain.
Sir, I would urge the Government to look into these issues and make the necessary changes so that India gets a progressive law on mental healthcare, which would work towards raising awareness and eradicating the stigma attached to mentally ill people.
Thank you, Sir.
